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3.
Medicine (Baltimore) ; 99(32): e21410, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769871

RESUMO

It is often assumed that children and their caregivers either stay in care together or discontinue together, but data is lacking on caregiver-child retention concordance. We sought to describe the pattern of care among a cohort of human immunodeficiency virus (HIV) infected children and mothers enrolled in care at the Manhiça District Hospital (MDH).This was a retrospective review of routine HIV clinical data collected under a larger prospective HIV cohort study at MDH. Children enrolling HIV care from January 2013 to November 2016 were identified and matched to their mother's HIV clinical data. Retention in care for mothers and children was assessed at 24 months after the child's enrolment. Multinomial logistic regression was performed to evaluate variables associated with retention discordance.For the 351 mother-child pairs included in the study, only 39% of mothers had concordant care status at baseline (23% already active in care, 16% initiated care concurrently with their children). At 24-months follow up, a total of 108 (31%) mother-child pairs were concordantly retained in care, 88 (26%) pairs were concordantly lost to follow up (LTFU), and 149 (43%) had discordant retention. Pairs with concurrent registration had a higher probability of being concordantly retained in care. Children who presented with advanced clinical or immunological stage had increased probability of being concordantly LTFU.High rates of LTFU as well as high proportions of discordant retention among mother-child pairs were found. Prioritization of a family-based care model that has the potential to improve retention for children and caregivers is recommended.


Assuntos
Medicina de Família e Comunidade , Infecções por HIV/psicologia , Infecções por HIV/terapia , Perda de Seguimento , Mães/psicologia , Cooperação do Paciente/psicologia , Adulto , Fármacos Anti-HIV/uso terapêutico , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Moçambique
4.
Afr J Prim Health Care Fam Med ; 12(1): e1-e3, 2020 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-32787394

RESUMO

Coronavirus disease 2019 (COVID-19), the respiratory disease caused by the virus now called as SARS-CoV-2 and first identified in Wuhan, China, has spread to all regions of the world. At the time of this write-up, over 5.1 million people had been infected by the virus globally. The World Health Organization estimates that in Africa over 5 million people would need hospital admission during the course of the pandemic. Interventions to prevent the disease include social distancing and nationwide lockdowns, which, whilst necessary, have had negative effects not only on the economic status of many but also on primary care and especially the management of chronic illnesses. There are opportunities for primary care physicians to continue learning, lend humanitarian aid and provide the needed care in this context. Social media has promising applications in this rapidly changing context.


Assuntos
Infecções por Coronavirus/terapia , Pandemias , Papel do Médico , Médicos de Família , Pneumonia Viral/terapia , Botsuana/epidemiologia , Infecções por Coronavirus/epidemiologia , Medicina de Família e Comunidade , Humanos , Pneumonia Viral/epidemiologia , Atenção Primária à Saúde
7.
N Z Med J ; 133(1518): 33-42, 2020 07 17.
Artigo em Inglês | MEDLINE | ID: mdl-32683430

RESUMO

AIMS: The overall rate of community antibiotic dispensing in New Zealand in recent decades has been high when compared with many other nations, but since 2015 has consistently declined each year. We aimed to determine whether the magnitude of reductions in community antibiotic dispensing in New Zealand between 2015 and 2018 differed in relation either to the patient's demographic features or in relation to the primary health organisation of the patient's registered general practitioner. METHODS: Demographic data on all patients registered with a general practice in New Zealand, and on all community pharmacy antibiotic dispensing for these patients during 2013-2018 were obtained from national healthcare databases. The rates of dispensing for patients registered with a general practitioner were measured as antibiotic courses dispensed per 1,000 population per day, and as defined daily doses per 1,000 population per day. RESULTS: Total community antibiotic dispensing in New Zealand, measured as defined daily doses per 1,000 inhabitants per day, decreased by 13.8% during 2015-2018, an average annual reduction of 4.6% per year, with especially large reductions in dispensing of amoxicillin/clavulanate, fluoroquinolones and macrolides. The reductions in dispensing were greatest in children aged 0-4 years old, but lesser reductions were seen in all age groups. Antibiotic dispensing declined regardless of patient ethnicity or level of socioeconomic deprivation. There were marked differences between primary health organisations in the size of the reductions in antibiotic dispensing during 2015-2018, which ranged between 4.8% for the Te Tai Tokerau PHO to 21.5% for the Ngati Porou Hauora Charitable Trust PHO. CONCLUSIONS: Total community antibiotic dispensing has reduced significantly in New Zealand between 2015 and 2018, with large disparities between primary health organisations in the size of the reductions. The overall rates of antibiotic dispensing remain high for non-Maori and non-Pacific people, and prescribers should aim to further reduce inappropriate antibiotic prescribing for these populations. However, the overall rate of antibiotic dispensing for Maori and Pacific people may now approximate an optimal level. Prescribers should aim to further reduce inappropriate antibiotic prescribing, but also to increase appropriate antibiotic prescribing for these populations.


Assuntos
Antibacterianos/farmacologia , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/tendências , Medicina de Família e Comunidade/estatística & dados numéricos , Farmácias/estatística & dados numéricos , Padrões de Prática Médica , Humanos , Nova Zelândia , Estudos Retrospectivos
8.
Afr J Prim Health Care Fam Med ; 12(1): e1-e4, 2020 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-32634002

RESUMO

Ten family physicians and family medicine registrars in a South African semi-rural training complex reflected on the coronavirus disease 2019 (COVID-19) crisis during their quarterly training complex meeting. The crisis has become the disruptor that is placing pressure on the traditional roles of the family physician. The importance of preventative and promotive care in a community-oriented approach, being a capacity builder and leading the health team as a consultant have assumed new meanings.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Medicina de Família e Comunidade/organização & administração , Pneumonia Viral/terapia , Padrões de Prática Médica/organização & administração , Atenção Primária à Saúde/organização & administração , Atitude do Pessoal de Saúde , Fortalecimento Institucional/organização & administração , Competência Clínica , Medicina de Família e Comunidade/educação , Humanos , Pandemias , Médicos de Família/organização & administração , África do Sul
9.
Afr J Prim Health Care Fam Med ; 12(1): e1-e3, 2020 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-32634004

RESUMO

The Coronavirus disease 2019 (COVID-19) pandemic has been ravaging Nigeria and the world with increasing morbidity and mortality. Despite efforts by the Nigerian government implemented through the Nigerian Centre for Disease Control (NCDC) to reduce the scourge of the disease through public enlightenment and regular updates, the number of new cases and mortalities from COVID-19 are still increasing. Family physicians (FPs) who are the first contact of care for most patients accessing private and public health facilities in Nigeria have been working tirelessly to reduce the scourge of the pandemic in Nigeria. They continuously update themselves through regular webinars and online resources and guidelines provided by the Society of Family Physicians of Nigeria (SOFPON). Measures adopted by FPs across the country in the fight against the scourge include triaging patients as they present to the family medicine clinics; health education and enlightenment of the populace; and ensuring social distancing, regular handwashing and compulsory use of face mask by both physicians and patients during clinical consultations. Other measures include incorporating family-focused behavioural interventions in their practice, home-based care to reduce the number of persons visiting the hospital, telemedicine and Hospice and palliative care services to the elderly and terminally ill. In conclusion, FPs in Nigeria are helping to reduce the scourge of COVID-19 through patient education and innovative healthcare delivery that does not put patients at increased risk of the disease whilst promptly recognising potential COVID-19 patients and referring them for early diagnosis and treatment.


Assuntos
Infecções por Coronavirus/terapia , Medicina de Família e Comunidade/organização & administração , Papel do Médico , Pneumonia Viral/terapia , Prevenção Primária/organização & administração , Betacoronavirus , Pessoal de Saúde/psicologia , Humanos , Nigéria , Pandemias , Médicos de Família , Telemedicina/organização & administração
10.
Wiad Lek ; 73(6): 1252-1256, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32723963

RESUMO

OBJECTIVE: The aim of our work was to conduct a comprehensive assessment of the frequency and features of patient's complaints, the prevalence of major vascular risk factors in patients who applied for medical care to the ambulatory of general practice - family medicine and analysis of the results based on questionnaires using the original questionnaire. PATIENTS AND METHODS: Materials and methods: It was compiled a questionnaire according to which 87 people from 18 to 60 years old, were interviewed who applied to the general practice outpatient clinic - family medicine. The questionnaire included questions related to the well-being of those who went to the outpatient clinic, questions regarding the lifestyle, nutrition, bad habits, the specifics of work and the chronic pathology of the respondents and their relatives. First group included 42 (48.3%) middle-aged patients according to WHO classification, second group - 45 (51.7%) young adults. RESULTS: Results: With the help of questioning of the patients who went to the outpatient clinic, we identified and statistically confirmed the risks of the occurrence and development of pathology of arterial hypertension and coronary heart disease. The odds ratio is quite high in persons with memory impairment, attention - 4.41; feeling of heaviness in the head - 3.45; dizziness - 5.02; heartache - 5.54; overweight - 6.80; not involved in sports - 3.66 in our survey groups. CONCLUSION: Conclusions: In this study we have determined the risk groups of patients and the predictors of development of cardio- and cerebrovascular pathology in patients of the first group are revealed.


Assuntos
Instituições de Assistência Ambulatorial , Medicina de Família e Comunidade , Adolescente , Adulto , Humanos , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Inquéritos e Questionários , Adulto Jovem
12.
Afr J Prim Health Care Fam Med ; 12(1): e1-e3, 2020 Jun 03.
Artigo em Inglês | MEDLINE | ID: covidwho-543361

RESUMO

The novel coronavirus disease 2019 (COVID-19) pandemic has disrupted many lives worldwide. Training programmes in academic institutions have also been affected by the pandemic. Teaching and learning family medicine and public health medicine in the COVID-19 era require adjustments to training activities. At the University of Botswana, the pandemic presented an opportunity to steer training programmes in the Department of Family Medicine and Public Health Medicine more towards service-learning. The department collaborated with the Ministry of Health and Wellness as well as the District Health Management teams in the national response to the pandemic as essential service providers. The increased demands for service provision were balanced with educational opportunities for trainees during the COVID-19 public health emergency. Including structured ongoing reflections for trainees involved in the COVID-19 response helps to connect service and the academic curriculum.


Assuntos
Infecções por Coronavirus/epidemiologia , Medicina de Família e Comunidade/educação , Pandemias , Pneumonia Viral/epidemiologia , Saúde Pública/educação , Botsuana/epidemiologia , Currículo , Humanos , Universidades/organização & administração
13.
Hong Kong Med J ; 26(3): 176-183, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32475841

RESUMO

INTRODUCTION: This study evaluated the preparedness of family doctors during the early phase of the coronavirus disease 2019 (COVID-19) outbreak in Hong Kong. METHODS: All members of the Hong Kong College of Family Physicians were invited to participate in a cross-sectional online survey using a 20-item questionnaire to collect information on practice preparedness for the COVID-19 outbreak through an email followed by a reminder SMS message between 31 January 2020 and 3 February 2020. RESULTS: Of 1589 family doctors invited, 491 (31%) participated in the survey, including 242 (49%) from private sector. In all, 98% surveyed doctors continued to provide clinical services during the survey period, but reduced clinic service demands were observed in 45% private practices and 24% public clinics. Almost all wore masks during consultation and washed hands between or before patient contact. Significantly more private than public doctors (80% vs 26%, P<0.001) experienced difficulties in stocking personal protective equipment (PPE); more public doctors used guidelines to manage suspected patients. The main concern of the respondents was PPE shortage. Respondents appealed for effective public health interventions including border control, quarantine measures, designated clinic setup, and public education. CONCLUSION: Family doctors from public and private sectors demonstrated preparedness to serve the community from the early phase of the COVID-19 outbreak with heightened infection control measures and use of guidelines. However, there is a need for support from local health authorities to secure PPE supply and institute public health interventions.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Surtos de Doenças/prevenção & controle , Medicina de Família e Comunidade/organização & administração , Pesquisas sobre Serviços de Saúde/métodos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Inquéritos e Questionários , Técnicas de Laboratório Clínico/métodos , Técnicas de Laboratório Clínico/estatística & dados numéricos , Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/diagnóstico , Surtos de Doenças/estatística & dados numéricos , Feminino , Hong Kong/epidemiologia , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Médicos de Família/estatística & dados numéricos
14.
Afr J Prim Health Care Fam Med ; 12(1): e1-e3, 2020 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-32501020

RESUMO

The novel coronavirus disease 2019 (COVID-19) pandemic has disrupted many lives worldwide. Training programmes in academic institutions have also been affected by the pandemic. Teaching and learning family medicine and public health medicine in the COVID-19 era require adjustments to training activities. At the University of Botswana, the pandemic presented an opportunity to steer training programmes in the Department of Family Medicine and Public Health Medicine more towards service-learning. The department collaborated with the Ministry of Health and Wellness as well as the District Health Management teams in the national response to the pandemic as essential service providers. The increased demands for service provision were balanced with educational opportunities for trainees during the COVID-19 public health emergency. Including structured ongoing reflections for trainees involved in the COVID-19 response helps to connect service and the academic curriculum.


Assuntos
Infecções por Coronavirus/epidemiologia , Medicina de Família e Comunidade/educação , Pandemias , Pneumonia Viral/epidemiologia , Saúde Pública/educação , Botsuana/epidemiologia , Currículo , Humanos , Universidades/organização & administração
15.
Medicine (Baltimore) ; 99(24): e20586, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541490

RESUMO

Like research in general internal medicine, family medicine research can play an important role in improving medical knowledge. We aimed to compare articles published in family medicine journals with articles published in general internal medicine journals. In this bibliometric study, we retrieved 658 randomly selected quantitative articles published in 2016 in 18 high impact factor journals of family medicine and general internal medicine. We extracted the following data: author (gender, number of publications, and place of residence of the first author), paper (number of participants, study design) and journal characteristics (journal discipline, 2015 impact factor). We compared the two groups of articles, using multivariate logistic regressions adjusted for impact factor and intra-cluster correlations. The first author of the articles published in family medicine journals, compared to general internal medicine journals, was more often a woman (OR 2.8 [95%CI 1.8-4.4], P-value < .001), living in the Western world (OR 14.4 [95%CI 6.0-34.4], P-value < .001), and a less experienced researcher (<5 vs >15 publications: OR 2.4 [95%CI 1.5-4.0], P-value .01). In addition, these studies generally included more participants (>1000 vs <100: OR 3.5 [95%CI 1.4-8.6], P-value .02). There was no statistically significant difference in the study design between the two groups of articles (P-value .25). Despite some differences between the two groups of articles, studies published in family medicine journals do not appear to be any less ambitious in terms of study design and sample size than those published in general internal medicine journals.


Assuntos
Bibliometria , Medicina de Família e Comunidade , Medicina Interna , Publicações Periódicas como Assunto , Editoração/estatística & dados numéricos
16.
Praxis (Bern 1994) ; 109(8): 596-607, 2020.
Artigo em Alemão | MEDLINE | ID: mdl-32517603

RESUMO

The Role of Ultrasonography in Family Medicine Abstract. This overview describes the various applications of sonography in family practice. After an outline of the requirements for examiners and equipment, the individual areas of examination are discussed, in part with the most important diagnostic criteria, and illustrated with case studies using images and videos. Readers should be encouraged to make broad use of sonography and to attend regular further training and education courses in this field.


Assuntos
Medicina de Família e Comunidade , Ultrassonografia , Humanos
17.
Aust J Gen Pract ; 49(6): 364-368, 2020 06.
Artigo em Inglês | MEDLINE | ID: covidwho-436804

RESUMO

BACKGROUND AND OBJECTIVES: As a result of the pandemic, family physicians face the additional challenge of navigating COVID-19. The aim of this study was to provide simulated training for best-practice management of COVID-19 presentations for residency program trainees in Shanghai, China. METHOD: A simulated suspected COVID-19 case was designed on the basis of a real patient. The simulation included: pre­ and post-simulation surveys, a PowerPoint presentation, simulation practice, debriefing and reflection. Improvement in survey outcomes was assessed using a paired t-test. RESULTS: A total of 25 trainees participated in the simulation, consisting of first-, second- and third-year family medicine residents. Significant improvement was observed in their knowledge of COVID-19, and sub-analysis showed that all three grades of residents improved their knowledge significantly. Ninety-six per cent of participants believed the simulation was very helpful. DISCUSSION: The simulation scenario improves crisis management skills for family physicians managing the high risk of transmission of respiratory infectious diseases. Higher-order learning outcomes will be explored in future training programs.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Medicina de Família e Comunidade/educação , Internato e Residência/métodos , Pneumonia Viral/terapia , Treinamento por Simulação/métodos , Adulto , China , Competência Clínica , Feminino , Humanos , Masculino , Pandemias
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